Provider Demographics
NPI:1265733455
Name:RUIZ, JOSE (PMHNP,RN, LMSW)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:RUIZ
Suffix:
Gender:M
Credentials:PMHNP,RN, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 THOMPSON ST
Mailing Address - Street 2:APT-25
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-5308
Mailing Address - Country:US
Mailing Address - Phone:212-844-9259
Mailing Address - Fax:
Practice Address - Street 1:132 THOMPSON ST
Practice Address - Street 2:APT-25
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-5308
Practice Address - Country:US
Practice Address - Phone:212-844-9259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-04
Last Update Date:2021-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY11089101104100000X
NY22-542744163W00000X
NYF400966-01363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered Nurse